688 



HERNE BAY 



HERNIA 



Herne Bay* a watering-place of Kent, 12 

 miles W. of Margate. Founded in 1830, it has a 

 pier 1213 yards long, an esplanade 1 mile long, and 

 a handsome clock-tower. Bishop Ridley was vicar 

 of Herne in 1538-40. Pop. (1891) 3829. 



Herne the Hunter, a figure in popular 

 tradition, long supposed to range at midnight 

 around an ancient oak in Windsor Forest. He is 

 referred to in Shakespeare's Merry Wives of 

 Windsor, and Herne's Oak continued to be an 

 object of interest until it was blown down on 31st 

 August 1863. The Queen planted a young oak on 

 the spot where the patriarch had stood, as was 

 supposed, for 650 years. 



Hernia ( Lat. ; probably from Gr. ernos, ' a 

 sprout ' ), in its widest sense, signifies a protru- 

 sion, through an abnormal or accidental opening, 

 of any organ from its natural cavity. Although 

 hernia may occur in many parts of the body, the 

 word, used by itself, is restricted to signify pro- 

 trusion of the abdominal viscera, the condition 

 popularly called rupture. 



The way in which hernia may arise will be 

 readily understood if we bear in mind that the 

 abdominal viscera are subject to constant pressure 

 from the diaphragm and other surrounding muscles. 

 If at any point the walls of the belly are not suffi- 

 ciently strong to resist this pressure some portion 

 of the viscera is driven through them, and a nernial 

 tumour is formed. Certain parts of the abdominal 

 walls, especially the inguinal and crural rings, and 

 the umbilicus, being weaker than others, hernia 

 most frequently occurs at these points. In some 

 instances hernia is congenital, from abnormal 

 deficiency of the walls ; in other cases it may 

 arise at any period of life as a result of violent 

 bodily exertion. Sex, age, and occupation seem 

 to have a marked influence in predisposing to 

 hernia. Men are far more liable (in about the 

 proportion of four to one) to this disease than 

 women ; though they are less so to those forms 

 of the affection known as femoral and umbilical 

 hernia. According to Malgaigne, in France one 

 man in thirteen, and one woman in fifty-two, are 

 the subjects of hernia. In respect of age he found 

 that the liability is least about the age of thirteen 

 (one in seventy-seven), after which it progressively 

 increases until the close of life, rising at seventy 

 to seventy-five to one out of every three. 



A hernia is almost always composed of a sac and 

 its contents. The sac is a portion of the Peritoneum 

 (q.v. ) corresponding to the aperture at which the 

 hernia protrudes. It is pushed forward by the pro- 

 truding viscera, and forms a pouch. The contents 

 vary greatly, but generally consist of a portion of 

 the small intestine (particularly of the ileum), 

 forming the variety of hernia known as enterocele. 

 Omentum is often found in hernial sacs, either 

 with or without intestine. Besides the viscera, 

 the sac always contains a certain quantity of fluid 

 secreted by its interior. Hernia is divisible ( 1 ) into 

 reducible, or returnable into the abdomen, irre- 

 ducible, and strangulated; and (2), according to 

 its situation, into inguinal, femoral, &c. 



The treatment of reducible hernia may be pallia- 

 tive or radical. The palliative -treatment consists 

 in the application of a truss ( see below ) to retain the 

 protrusion within the cavity of the abdomen. Each 

 particular kind of hernia (femoral, umbilical, &c. ) 

 requires its special form of truss ; and before apply- 

 ing it the hernia must be reduced by placing the 

 patient on his back, relaxing the muscles by bend- 

 ing the thigh upon the abdomen, and pressing the 

 tumour back in the proper direction. The truss 

 should then be put on, and should be worn during 

 the whole of the day ; and if the patient will 

 submit to wear it (or a lighter one) during the 



night, so much the better. The means that have 

 been contrived to effect a radical cure are too 

 purely surgical for description in these pages. 

 Below the age of puberty, and if the hernia is 

 recent, a radical cure is sometimes effected by 

 wearing the truss for two or three years. 



In irreducible hernia the protruded viscera can- 

 not be returned into the abdomen, but there is no 

 impediment to the passage of their contents or to 

 their circulation. In these cases the patient is 

 often liable to dragging pains in the abdomen, and 

 to attacks of vomiting, in consequence of the move- 

 ments of the abdominal organs being checked by 

 the ornentum or intestines being fixed. There is 

 also constant danger of this hernia passing into the 

 strangulated form. The treatment may be either 

 palliative or radical. The palliative treatment con- 

 sists in the employment of a truss with a hollow 

 pad that shall embrace the hernia, and prevent any 

 additional protrusion. An irreducible hernia may 

 sometimes be converted into a reducible one by 

 keeping the patient in the recumbent position, and 

 on very low diet, for two or three months ; at the 

 same time keeping the bowels open by laxatives 

 and injections, and maintaining equable pressure 

 over the tumour. Radical cure is, as in the case 

 of reducible hernia, by operation. 



Hernia is said to be strangulated when a portion 

 of intestine or omentum that is protruded is so 

 tightly constricted that it not only cannot be 

 returned into the abdomen, but has its circulation 

 arrested. This form is highly dangerous, because, 

 if relief is not speedily afforded, the strangulated 

 part becomes gangrenous. The causes of strangula- 

 tion are various, but this condition most commonly 

 arises from a sudden violent eflbrt, by which a fresh 

 portion of intestine is driven into a pre-existing 

 hernia, which it distends to such a degree as to 

 produce this complication. The most prominent 

 early symptoms are flatulence, colic pains, &c. 

 They are succeeded by vomiting first of the con- 

 tents of the stomach, then of mucus and bile, and 

 lastly of faecal matters, owing to inverted peristaltic 

 action. If relief is not obtained the inflammation 

 that commences in the sac extends to the peri- 

 toneum, and the ordinary signs of peritonitis 

 appear. After a variable time comes gangrene or 

 mortification of the part, and the patient speedily 

 sinks. 



The surgeon first tries to return the intestine, as 

 in the preceding cases. This manipulation, termed 

 the taxis, may be assisted by the internal use of 

 chloroform, inhaled till it produces complete relaxa- 

 tion of the muscles, by the hot bath, &c. If this 

 fails he must have recourse to the knife to divide 

 the constriction. 



The necessity of having recourse to a suitable 

 truss the moment that the slightest protrusion 

 shows itself in an T of the parts liable to hernia 

 cannot be too strongly urged as a matter of 

 necessary general knowledge. At whatever period 

 of life a hernia occurs, if properly attended to and 

 judiciously supported, it usually gives little trouble, 

 and if it occurs in early life, it may often be cured ; 

 whereas, if it be neglected, increase of bulk, and, 

 subsequently, diseased states of the parts, often 

 terminating in death, will almost certainly occur. 

 A truss consists essentially of a pad or cushion 

 attached to a metallic spring, with straps so 

 arranged that its position may be retained during 

 the varied postures of the body. A surgeon should 

 always be consulted in the choice of the instru- 

 ment. ' The practice,' says Mr Birkett, 'of leav- 

 ing cases of rupture in the hands of mere trades- 

 men cannot be too strongly censured. Amongst 

 the poor we constantly observe the lamentable 

 effects of this proceeding.' Many varieties of 

 trusses have been invented. There are occasional 



